Patients with Parkinson Disease Experience Increased Perioperative Complications Following Cervical Decompression and Fusion: A Retrospective Review of the National Inpatient Sample

World Neurosurg. 2019 Dec;132:e463-e471. doi: 10.1016/j.wneu.2019.08.114. Epub 2019 Aug 27.

Abstract

Background: Despite improved medical management, the incidence of spinal pathology remains high in patients with Parkinson disease (PD). Several studies have investigated lumbar spine surgery in this population, but data regarding costs and perioperative complications for patients undergoing cervical decompression/fusion on a nationwide scale are lacking.

Methods: Cases of cervical spinal decompression, fusion, or exploration in years 2008-2014 were collected via the Healthcare Cost and Utilization Project National Inpatient Sample. Demographics, complications, outcome, and total charges were compared in patients with and without PD (NPD). Confounding variables were identified for multivariate analysis.

Results: Data were available for 195,341 cervical spine cases, of which PD was prevalent in 779 cases (0.4%). Cases with PD experienced greater overall complication rates (12.5 vs. 7.6%; P < 0.001). Multivariate analysis revealed longer lengths of stay for the PD cohort (mean = 1.21 days longer; P < 0.001) and decreased routine discharge (odds ratio = 0.308; P < 0.001). There was no significant difference in mean total charges between PD and NPD (-$1532; P = 0.337). Mortality rates did not significantly differ for either group.

Conclusions: Although patients with PD experience greater complication rates and non-home discharges following cervical spine surgery compared with NPD patients, the overall clinical impact of these results may be minimal relative to surgery at other spinal levels in this population.

Keywords: Anterior cervical diskectomy and fusion; Parkinson disease; Posterior cervical diskectomy and Fusion.

MeSH terms

  • Aged
  • Cervical Vertebrae / surgery*
  • Decompression, Surgical / adverse effects*
  • Female
  • Humans
  • Incidence
  • Inpatients
  • Length of Stay
  • Male
  • Middle Aged
  • Parkinson Disease* / complications
  • Postoperative Complications / epidemiology*
  • Retrospective Studies
  • Spinal Diseases / complications
  • Spinal Diseases / surgery
  • Spinal Fusion / adverse effects*